Steroid Injections for Back Pain: Understanding the Risks

By Dani Stekel D.C.

Chronic lower back pain is no fun. It is so not fun that many patients who are afflicted with it will try almost anything to rid themselves of the constant pain and discomfort. Increasingly, medical doctors are prescribing epidural steroid injections – anti-inflammatory steroid compounds injected directly into the spinal area – to relieve the pain. While there are cases in which this approach has reduced people’s pain, there are also enormous risks involved with epidural steroid injections. Those who suffer from chronic back pain should be aware of these risks and should discuss them with their physician before considering this treatment.
First, there is the question of effectiveness. Some patients have reported an actual increase in their pain level after the injection, not a reduction. The Food and Drug Administration, after all, has still not approved steroid injections for use in lower back pain because no one has been able to demonstrate long-term benefits of the treatment, only short-term pain relief. Second, there are risks associated with the injections themselves, ranging from infection and post-injection headaches to actual nerve damage. Although these types of risks are rare, occurring in only 0.1% to 0.5% of injections, they should still be considered.
Third, there are occasionally negative side effects from the treatment, including an increase in pain level, headaches, anxiety, sleeplessness, fever, reduced immune response and severe arthritis of the hips (avascular necrosis). Fourth, although these drugs may temporarily reduce inflammation, there is increasing evidence that they may contribute to bone loss in older patients. In one study conducted on over 3,000 patients at the Henry Ford Health System in Detroit, patients treated with steroids were found to be much more susceptible to vertebral fractures, and their risk of incurring these fractures increased by 21% with each round of treatments.
Finally, although it is limited so far to only one supplier of these medications, there is the possibility that the steroid medications themselves can be tainted and cause far more serious diseases than they are used to treat. Several cases of fungal meningitis have been linked to epidural steroid injections using medications supplied by one Massachusetts provider.
The purpose of this article is not to scare people away from injected steroid use. There are cases in which it has been of benefit. But there are questions about whether these medications are useful for treating back pain, and there are legitimate concerns about the treatment’s safety.
Therefore, the wisest approach might be to try other, safer, and more conservative treatments before you try epidural steroid injections. These alternative treatments include chiropractic care, massage, safer anti-inflammatory and pain-management medications, and simply allowing time to pass to see if the condition improves on its own. If you suffer from chronic lower back pain, by all means consult your medical practitioner, but don’t be afraid to also consult Doctors of Chiropractic, whose entire practice and philosophy is based drug-free, surgery-free and side-effect-free treatments for spinal problems.

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New York, NY 10019